Korean J Adult Nurs.  2024 Aug;36(3):191-202. 10.7475/kjan.2024.36.3.191.

Development of a Pressure Injury Machine Learning Prediction Model and Integration into Clinical Practice: A Prediction Model Development and Validation Study

Affiliations
  • 1Nurse, Samsung Medical Center, Seoul, Korea
  • 2Research Professor, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
  • 3Data Scientist, Samsung Medical Center, Data Service Team, Seoul, Korea
  • 4Wound/Ostomy/Continence Nurse, Samsung Medical Center, Seoul, Korea
  • 5Team Manager, Nursing Professional Development Team, Samsung Medical Center, Seoul, Korea
  • 6Chief Nursing Officer, Samsung Medical Center, Seoul, Korea
  • 7Professor, Department of Nursing, Gangseo University, Seoul, Korea
  • 8Director, Data Innovation Office, Samsung Medical Center, Seoul, Korea

Abstract

Purpose
The purposes of this study were to develop a prediction model for pressure injury using a machine learning algorithm and to integrate it into clinical practice.
Methods
This was a retrospective study of tertiary hospitals in Seoul, Korea. It analyzed patients in 12 departments where many pressure injuries occurred, including 8 general wards and 4 intensive care units from January 2018 to May 2022. In total, 182 variables were included in the model development. A pressure injury prediction model was developed using the gradient boosting algorithm, logistic regression, and decision tree methods, and it was compared to the Braden scale.
Results
Among the 1,389,660 general ward cases, there were 451 cases of pressure injuries, and among 139,897 intensive care unit cases, there were 297 cases of pressure injuries. Among the tested prediction models, the gradient boosting algorithm showed the highest predictive performance. The area under the receiver operating characteristic curve of the gradient boosting algorithm's pressure injury prediction model in the general ward and intensive care unit was 0.86 (95% confidence interval, 0.83~0.89) and 0.83 (95% confidence interval, 0.79~0.87), respectively. This model was integrated into the electronic health record system to show each patient's probability for pressure injury occurrence, and the risk factors calculated every hour.
Conclusion
The prediction model developed using the gradient boosting algorithm exhibited higher performance than the Braden scale. A clinical decision support system that automatically assesses pressure injury risk allows nurses to focus on patients at high risk for pressure injuries without increasing their workload.

Keyword

Clinical decision support system; Machine learning; Pressure injury
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